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How can we ensure vaccines are distributed equitably throughout the globe? Al Seib/Los Angeles Times via Getty Images
  • People in high income countries are receiving vaccinations much more quickly than people in low income nations.
  • Experts are trying to figure out ways to distribute COVID-19 vaccines more fairly.
  • Several proposals have been advanced, but a new paper finds fault with their guiding principles and says they are likely to fail.

“Although many people in rich countries will receive a vaccine for COVID-19 this year, many people in poor countries will likely have to wait years to get one,” says Nicole Hassoun of Binghamton University in New York.

Hassoun is the senior author of a new paper that describes the international distribution of COVID-19 vaccines and explores ways to make their distribution more equitable.

”Ethical vaccine allocation requires closing this gap and ensuring that everyone can access a vaccine as soon as possible.”

– Nicole Hassoun

Experts have proposed several approaches for achieving this goal. However, the paper concludes that these ideas will not succeed and suggests a series of principles that could improve them.

The paper, “Just Allocation of COVID-19 Vaccines,” appears in BMJ Global Health.

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The COVAX (COVID-19 Vaccines Global Access) facility is a collaboration between governments, companies, international organizations, and others whose aim is to speed up the manufacture and distribution of COVID-19 vaccines worldwide.

So far, 182 countries have joined. COVAX was convened under the auspices of the World Health Organization (WHO), The Coalition for Epidemic Preparedness Innovations (CEPI), and GAVI.

To date, COVAX has secured $2 billion for advance market commitment (AMC), which aims to accelerate vaccinations for people in 92 low- and middle-income countries.

In its first phase, COVAX aims to assist low income countries in vaccinating 3% of their populations, while high income nations can vaccinate up to 50% of their residents. However, it hopes that all member countries have vaccinated 20% of their population by the end of 2021.

The WHO also propose to distribute vaccines based on demographic considerations. It suggests that healthcare workers, people with comorbidities, the elderly, people from some high-risk sociodemographic groups, and some teachers receive vaccines first.

Outside COVAX, there is the Fair Priority model, which proposes that high income nations contribute to the global distribution of vaccines once their own infection rates drop below 1%. Under this program, the distribution of vaccines would target minimizing the number of years of life lost.

A fourth model proposed by Vanderbilt University in Nashville, TN, suggests allocating vaccines to countries that can demonstrate their ability to distribute them and provide healthcare. It gives priority to countries that have participated in the development and testing of COVID-19 interventions.

The recent paper indicates that all of the proposed models are flawed and suggests basing more promising vaccination campaigns on three guiding principles:

The paper says that proposals should address the health problems of individuals, not the characteristics of the countries in which they reside.

The authors write, “since most individuals have little choice as to their country of origin or residence, we should not discriminate against them based on location.”

They add that it is not possible to consider any proposal that allows high income nations to hoard vaccines or prioritize their own residents before sharing the medicine as fair.

Finally, they note that proposals whose goal is equality in vaccine distribution between nations fail to recognize that unfairness of distribution within those countries may also occur.

The paper explains that vaccination programs should explicitly aim at benefiting a population’s overall health, not just preventing harm from COVID-19.

Proposals should take into account the ways in which a vaccination program could interfere with existing attempts to address other health challenges in low income countries.

An emphasis on COVID-19 vaccinations could impede efforts to address other diseases, such as tuberculosis, malaria, and HIV, for example.

The paper says a proposal can only succeed when it includes “assisting countries with their vaccine distribution, production, and consumption.”

Proposals should provide regions with strategies most likely to succeed.

For example, vaccines that require extreme refrigeration may not be the best choice for countries without widespread energy supplies and whose transportation systems are incapable of distributing vaccines promptly.

Overall, the problem is the mindset informing the current proposals, says Massoud:

“Many proposals for equitable allocation let rich countries prioritize their populations. We must combat this scarcity mindset and expand access rather than just shift resources around.”

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